The case for pillows

Ah, our trusty pillow -- that support we prop up behind us to read; the comfy fluff-and-stuff that lulls us to sleep each night; a familiar companion for our travels. Benjamin Goldstein, M4, has now developed a new function for our pillow, and it's nothing short of lifesaving.

Goldstein has taken the practicality and accessibility of a standard-size pillow, and by slipping a custom-designed instructional pillowcase on it, he’s created an ideal tool for learning and practicing CPR.

Goldstein came up with the ingenious idea for his community-focused research project for OUWB’s Embark program, a four-year curriculum that focuses on research endeavors and scholarly presentation. His efforts were supported by program mentors Associate Professor Virginia Uhley, Ph.D., Department of Foundational Medical Studies/Department of Family Medicine and Community Health; and Assistant Professor Alan Silverman, D.O., cardiologist, Department of Internal Medicine.

With assistance from OUWB Medical Illustrator Audrey Bell, Goldstein created two pillowcase designs: one for infant CPR, another for adult/child CPR. Both designs have numbered steps on what to do before, during and after performing compression-only CPR. The design (printed on the pillowcases by Zazzle) outlines the torso and a hand/finger graphic, to guide proper placement for compressions.

The seeds for this idea – as well as for Goldstein’s medical path – were planted years ago , within his Baltimore household.

“My dad was an EMT and P.A., so I was involved in his community CPR classes at a young age,” says Goldstein, also an EMT.

“I'm third generation in a line of doctors, and my mom was a teacher, so my family was always focused on community care.”

Throughout years of teaching CPR in greater Baltimore, the Goldsteins encountered barriers, especially in underserved communities.

“The problem is that CPR manikins are expensive, so there’s sometimes a lack of affordability,” he explains. “There's also a lack of availability. There’s a limited amount of class time to use the manikins before they’re taken away [by suppliers].”

The Goldsteins started incorporating pillows, as a training adjunct. A key question was whether using a pillow was as good of an alternative as manikin training. Both in Baltimore and through OUWB’s Embark program, Goldstein has consistently built the case that it is.

Pillow fight

“It’s vital to ensure using a pillow is an effective training method,” says Goldstein. “It’s equally important that trainees feel confident with this method, especially in underserved communities, because we’re doing this to increase accessibility. To address these issues, we conducted two studies.”

In the first (“manikin v pillow”) study: one group of trainees viewed a CPR instructional video and then practiced chest compressions on a manikin; the other group viewed the video and practiced on a pillow (a certified CPR instructor was available to answer questions for both groups). Then the depth and rate of chest compressions in the manikin group was compared to the pillow group.

In the second (“confidence measuring”) study: surveys were given to trainees (before and after CPR training), to evaluate attitudes/confidence levels with learning/practicing pillow CPR. One of these sessions was held in Pontiac, and Ekaterina Clark, M2, assisted in the training.

The results?

“Training on a pillow was equal to training on a manikin [in regard to compression depth and rate],” says Goldstein. “Our surveys also showed training on a pillow resulted in significant gains in knowledge and improved attitudes and willingness to perform CPR.”

The next step has been spreading the knowledge through community CPR events.

“[Southeast Michigan’s] La Casa Amiga Mentor Program is currently doing this and giving out the pillowcases, enabling continued practice,” says Goldstein. “This kind of patient-centered care is empowering.”

Goldstein presented his findings and design to the American Heart Association. He’d love to see the pillowcases made available at medical facilities and physician offices (especially cardiology), as a teaching tool for patients and their families.

To date, Goldstein’s volunteered more than 6,000 hours for numerous community-based organizations.

His first volunteer job (age eight) was with Ahavas Yisrael Charity Fund, a partner of the Maryland Food Bank. He recently received a citation from the Maryland General Assembly, for more than 20 years of addressing food insecurity/fighting hunger exacerbated by COVID-19. He also helps manage the largest public access automated external defibrillator program in Baltimore.

With an impending decision on his primary care residency (leaning toward specializing in cardiology), Goldstein is on his way to making a difference in his corner of the world. He also has a far-reaching endgame for his pillowcase design.

"My dream is for them to be used for CPR training in sports arenas, as scheduled events," he says. "So instead of free T-shirts, it’ll be pillowcases."

Citing Ford Field as a 65,000-plus seating venue, Goldstein aims high.

“Arenas would be a great way to spread knowledge worldwide,” he says. "It’s sad to think of all the lives lost due to lack of CPR training, but we can work toward an untold number being saved."